Outcomes in patients with anthracycline-induced cardiomyopathy undergoing left ventricular assist devices implantation

Avirup Guha, Cesar Caraballo, Prantesh Jain, P. Elliott Miller, Jocelyn Owusu-Guha, Katherine A.A. Clark, Eric J. Velazquez, Tariq Ahmad, Lauren A. Baldassarre, Daniel Addison, Neal L. Weintraub, Nihar R. Desai

Research output: Contribution to journalArticlepeer-review

Abstract

Aims: Improved cancer survivorship has led to a higher number of anthracycline-induced cardiomyopathy patients with end-stage heart failure. We hypothesize that outcomes following continuous-flow LVAD (CF-LVAD) implantation in those with anthracycline-induced cardiomyopathy are comparable with other aetiologies of cardiomyopathy. Methods and results: Using the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 2008 to 2017, we identified patients with anthracycline-induced cardiomyopathy who received a CF-LVAD and compared them with those with idiopathic dilated (IDM) and ischaemic cardiomyopathies (ICM). Mortality was studied using the Cox proportional hazards model. Other adverse events were evaluated using competing risk models. Overall, 248 anthracycline-induced cardiomyopathy patients underwent CF-LVAD implantation, with a median survival of 48 months, an improvement compared with those before 2012 [adjusted hazards ratio (aHR): 0.53; confidence interval (CI): 0.33–0.86]. At 12 months, 85.1% of anthracycline-induced cardiomyopathy, 86.0% of IDM, and 80.2% of ICM patients were alive (anthracycline-induced cardiomyopathy vs. IDM: aHR: 1.12; CI: 0.88–1.43 and anthracycline-induced cardiomyopathy vs. ICM: aHR: 0.98; CI: 0.76–1.28). Anthracycline-induced cardiomyopathy patients had a higher major bleeding risk compared with IDM patients (aHR: 1.23; CI: 1.01–1.50), and a lower risk of stroke and prolonged respiratory support compared to ICM patients (aHR: 0.31 and 0.67 respectively; both P < 0.05). There was no difference in the risk of major infection, acute kidney injury, and venous thromboembolism. Conclusions: After receiving a CF-LVAD, survival in patients with anthracycline-induced cardiomyopathy is similar to those with ICM or IDM. Further research into differential secondary endpoints-related disparities is warranted.

Original languageEnglish (US)
Pages (from-to)2866-2875
Number of pages10
JournalESC heart failure
Volume8
Issue number4
DOIs
StatePublished - Aug 2021

Keywords

  • Anthracycline
  • Bleeding
  • Continuous-flow LVAD
  • INTERMACS
  • Mortality
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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